VCU NMT Program Adrenal Scintigraphy Aldosteronism Addison’s Cushing’s Virilizing Adenomas Pheochormocytomas Neuroblastomas Adrenal Cortical Pathologies:
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VCU NMT ProgramAdrenal Scintigraphy
AldosteronismAddison’sCushing’sVirilizing Adenomas
PheochormocytomasNeuroblastomas
Adrenal Cortical Pathologies:
Adrenal Medulla Pathologies:
Adrenal Cortex
Adrenal Medulla
VCU NMT ProgramAdrenal Scintigraphy
NP59 is one component of imaging that has already been covered in class via a previous lecture. Therefore we will continue with 131I mIBG
Adrenal Medulla imaging for determination of Medullar metastatic lesions is performed with I131 labeled mIBG, or I123 labeled mIBG which is not commercially available at this time.
Detection of adrenal medulla activity is primarily used in the evaluation of neuroblastoma and pheochromocytoma.
VCU NMT ProgramAdrenal Scintigraphy
VCU NMT ProgramAdrenal Scintigraphy
Neuroblastoma is a form of cancer that usually occurs in infancy and childhood. The term neuro indicates "nerves," while blastoma refers to a cancer that affects immature or developing cells.
Nearly 90% of cases are diagnosed by age 6. When detected early, neuroblastomas can usually be treated effectively. However, in as many as seven out of 10 cases, the disease is not diagnosed until it has already metastasized (spread). Overall, about 40% of children with neuroblastomas can be cured with a combination of surgery, followed by chemotherapy and/or radiation therapy.
VCU NMT ProgramAdrenal Scintigraphy
Pheochromocytomas are vascular tumors of adrenal medulla tissue characterized by hypersecretion of epinephrine and norepinephrine. This condition puts the patient in a prolonged version of flight or flight and ultimately wears the body down.
Pheochromocytomas may be found in the adrenal medulla or as metastatic tumors along the sympathetic ganglia (throughout the thorax and abdomen, but commonly along the vertebra and aorta).
VCU NMT ProgramAdrenal Scintigraphy
Specific points which you should remember:
•Before administering mIBG the patient should be treated with Lugol’s solution which blocks thyroid uptake of free I131.•Lugol’s administration should continue for 6 -7 days.•Administration of NP-59 I131 should be slow to prevent reactions.
•mIBG should only be used for Adrenal Medulla pathologies.
•Normal areas of uptake include salivary glands, liver, spleen, heart, GI tract, and bladder.
•Many drugs interfere with uptake of mIBG in medulla tissue.
•Sequential imaging should be performed to help identify normal vs. abnormal uptake.•Empty bladder before imaging.
1. antidepressants2. antihypertensives3. sympathomimetic: decongestants cocaine speed
Obtain a complete list of medications and check with radiologist.
VCU NMT ProgramAdrenal Scintigraphy
AldosteronismAddison’sCushing’sVirilizing Adenomas
Adrenal Cortical Pathologies:
PheochormocytomasNeuroblastomas
Adrenal Medulla Pathologies:
mIBG
NP-59Review
VCU NMT ProgramAdrenal Scintigraphy
24 hour mIBG I131 for Pheochromocytoma
VCU NMT ProgramAdrenal Scintigraphy
48 hour mIBG for Pheochromocytoma
VCU NMT ProgramAdrenal Scintigraphy
48 hour I131 mIBG for Neuroblastoma
VCU NMT Program
72 hour I131 mIBG 4 year old.
E.
VCU NMT ProgramAdrenal Scintigraphy
48 hour I131 mIBG for Neuroblastoma
VCU NMT ProgramAdrenal Scintigraphy
Neuroblastoma in 4 yo.
Wide spread metastatic evolvement of bone marrow.
VCU NMT ProgramAdrenal Scintigraphy
Metastatic Pheochromocytoma in liver
VCU NMT ProgramAdrenal Scintigraphy
48 hour I131 mIBG for Pheochromocytoma
VCU NMT ProgramAdrenal Scintigraphy
Generally, Neuroblastomas are imaged at 48 and 72 hours with I131 mIBG.
Pheochormocytomas are generally imaged at 24 and 48 hours.
The timing difference is largely due to Pheochromocytomas being much more vascular; therefore, they demonstrate more rapid accumulation of the radiopharmaceutical.
Sequential imaging (subsequent days days) helps to distinguish normal vs abnormal uptake.
How?
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